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General NPI Number Information
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NPI Number | 1922366087
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Entity Type | Organization
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Legal Business Name | ROD W GORE DDS PC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 8535 E HARTFORD DR STE 208
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5438
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Country | US
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Telephone | 480-585-6225
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Fax |
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Provider Business Mailing Address
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Address Line | 8535 E HARTFORD DR STE 208
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5438
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Country | US
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Telephone | 480-585-6225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROD W GORE
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Credential | DDS
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Telephone | 480-585-6225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D3767
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License Number State | AZ
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